This past month, I have had quite a few frantic calls from stressed out moms who have fussy babies and are hoping that The Calm Baby Cookbook could help. After a short conversation, their problem was easily diagnosed over the phone. These women were experiencing problems with breastfeeding because of well meaning, but totally incorrect advice from prenatal instructors and support people in their lives.



The problematic advice is one that many of us have heard already. ?You must feed the baby for 10 minutes on one side and then switch to the other side and feed for another 10 minutes.? This advice is absolutely incorrect and contributes to so many breastfeeding problems for new moms. The result is a gassy, fussy baby who cannot be easily comforted. The underlying problem is what is called a foremilk/hindmilk imbalance.

Many people (health care practitioners and prenatal instructors included!) do not know that breastmilk changes throughout the breastfeeding session. For the first part of a feed, breastmilk contains more water and more sugar. It rehydrates the baby quickly and helps to fill the baby's stomach. Towards the end of a feed, breastmilk changes to contain more fat. The fatty part of the milk is very important as it helps a baby to digest breastmilk more easily and it helps a baby to feel full and satisfied at the end of the feed. The fatty part of breastmilk offers so many benefits to a baby: it contributes to nerve and brain development, it acts as a laxative and so much more.

If a woman switches sides before the baby is able to get the hindmilk, the result is a fussy, gassy baby who has green, explosive, frothy stools. This baby has lots of cramping and is so uncomfortable that she cries soon after a feed and cannot be consoled. The closest way for an adult to understand this discomfort is that it mimics quite well the feelings of lactose intolerance.

A baby who is able to feed on one side until the breast completely drains will usually fall asleep at the end of the feed and will slide off the breast, full and completely satisfied. It can be quite difficult to wake a baby after she is able to get her hindmilk from the feeding session and most babies are simply put to bed. Getting to the hindmilk is like having rich cheesecake at the end of a good meal. You feel relaxed and ready to go to bed. The same is for a baby after a good feed off of one breast.

If you have been breastfeeding your baby and switching breasts often, you can certainly change the way that you feed your baby so that she can get the hindmilk. It will take a few days (possibly up to a week) for your breasts to become used to this new feeding pattern, so you'll need to be patient. Breastmilk is produced from direct stimulation to nerve endings in your areola as your baby feeds. Because your breasts are being stimulated with each feed, they are accustomed to making lots of milk (possibly too much milk).

If your breasts are making lots and lots of milk, you will need to feed on one breast for many complete feeds to help your baby get a good feed on your hindmilk (anywhere from 2 to 5 feeds). Your breast should be soft at the end of the feed. If it still feels full, have the baby feed on that breast again. As you are feeding from the same breast often, the unused breast will become full of milk. Simply pump the side that is full FOR COMFORT ONLY: just enough so that you can feel comfortable without draining the breast. Again, breast milk is produced from direct sucking at the breast, whether from your baby or a breast pump. If you completely drain the second breast by pumping, you will make too much milk and it will be harder for your baby to get to the hindmilk. Your breasts will not be able to adapt to this new method of breastfeeding, and you will continue to have feeding difficulties.

Once the first breast has been drained, start with the second breast. You may have to feed for quite a few (2-5) complete feedings on the second side as well until the baby can drain the breast and it feels soft at the end of the feed. You may need to pump the first breast for comfort as well. Eventually, you will have one breast ready for a feed, the baby will be able to drain it completely, and fall off the breast fast asleep, full and completely satisfied.

Once your milk starts to regulate, you'll notice that:

?The breast that feeds the baby will be soft at the end of the feed.

?Your second breast will be slightly full and preparing itself for the next feed.

?Your baby will be satisfied at the end of the feed. She will start to sleep better ? deeper and longer.

If you and your baby are experiencing a foremilk/hindmilk imbalance, relax and know that this can be remedied easily over time. Many medical professionals who do not know or understand what a foremilk/hindmilk imbalance is, will tell you that ?you are not producing good milk? or that ?you are not producing the right kind of milk? or that ?your baby is allergic to your milk.? And then they will ask you to feed your baby a hypo-allergenic formula ?to let everything settle down.? Most women give up on breastfeeding at that point, especially since they have just been told that their body is incapable of feeding their child.

I am constantly amazed at how quick some professionals are to dismiss a woman's body as being inferior instead of recognizing that she has been given incorrect information on how to feed her child. Please know that many health care professionals or prenatal instructors do not understand breastfeeding or how it works and that you cannot assume that they do. Ask them about their breastfeeding training and experience. If they have not taken courses in breastfeeding, they are not qualified to offer advice or help you with your problems. Medical doctors are not taught about breastfeeding, or if they are, it is for 2 hours at some point in their school curriculum.

If you need help, see a lactation consultant as soon as you are having problems with your latch. You can also contact someone in La Leche League ? an organization of breastfeeding mothers who are more than willing to help you with your breastfeeding difficulties as they are personally experienced in feeding their own children. (You can find them listed in your local white pages or you can visit lalecheleague.org to find help close to you.) The La Leche League has a wonderful book called The Womanly Art of Breastfeeding. You will find it in any bookstore. You can also contact your local midwife; she will know of qualified people in your community who can help.

After your breastmilk regulates, if your baby is still fussy, especially between 5:30 and 11:30 at night, you may want to look at the foods that you are eating. Some foods that breastfeeding mother eat can irritate a baby's digestive system and cause fussiness and crying. You can find out more by visiting Dr. Melanie's website.